Jun 8, 2015

(CHICAGO) – Following up on yesterday’s story (ICD-10: Stop This Freight Train ... Or At Least Install Seat Belts!), we can report that the American Medical Association House of Delegates today unanimously adopted the Texas-backed proposal to ask the federal government to adopt a two-year, penalty-free grace period following the expected Oct. 1 mandatory implementation of the new ICD-10 coding system.

As the Reference Committee on Legislation noted in its report, “Our AMA will continue to prioritize our existing AMA policy that first seeks to stop the implementation of the ICD-10 code set and, only if a delay is not feasible, seek mitigation strategies.”

The delegates voted without objection in support of the grace period plan, which the reference committee cobbled together based on suggestions from the Alabama and Texas delegations as well as other states. The adopted language reads:

If a delay of ICD-10 implementation is not feasible, that our American Medical Association ask the Centers for Medicare & Medicaid Services (CMS) and other payers to allow a two-year grace period for ICD-10 transition, during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system. Physician payments will also not be withheld based on ICD-10 coding mistakes, providing for a true transition where physicians and their offices can work with ICD-10 over a period of time and not be penalized.

That our AMA educate physicians of their contractual obligations under Medicare and insurance company contracts should they decide to not implement ICD-10 and opt to transition to cash-only practices which do not accept insurance.

That our AMA aggressively promote this new implementation compromise to Congress and CMS since it will allow implementation of ICD-10 as planned, and at the same time protect patients’ access to care and physicians’ practices.

That our AMA provide the needed resources to accomplish this new compromise ICD-10 implementation and make it a priority.

That our AMA seek data on how ICD-10 implementation has affected patients and changed physician practice patterns, such as physician retirement, leaving private practice for academic settings, and moving to all-cash practices and that, if appropriate, our AMA release this information to the public.

Jun 7, 2015

(CHICAGO) -- Staring down the muzzle of the Oct. 1 mandatory deadline to implement the ICD-10 coding system, the American Medical Association House of Delegates searched for multiple ways to help U.S. physicians dodge a dangerous bullet.

Thanks to strong lobbying from AMA, the Texas Medical Association, and other physician groups, the original Oct. 1, 2013, ICD-10 deadline has been pushed back twice.

Dr. Fuller testifies at AMA

Both TMA and AMA still formally oppose ICD-10. They've pointed out that many physicians, especially those in small practices, are still not ready to use the new coding language. Some cite the high cost of transition; others blame electronic health record vendors that have not yet made ICD-10-compliant software available. Those who aren't ready run the risk of having all or some of their Medicare, Medicaid, and commercial insurance claims going unpaid.

TMA supports H.R. 2126, the Cutting Costly Codes Act of 2015, by U.S. Rep. Ted Poe (R-Humble), which would prohibit the government from requiring physicians and health care providers to use ICD-10.

Texas physicians at the AMA meeting spoke out about the dangers they foresee, especially for primary care practices. Greg Fuller, MD, a family physician from Keller, said the wide array of medical problems primary care physicians treat is forcing them to try to learn thousands of new codes.

"We need to stop ICD-10," Dr. Fuller told the Reference Committee on Legislation. "Any delay in pay is going to kill these practices."

Dr. Villarreal at reference committee

E. Linda Villarreal, MD, an internist in the Rio Grande Valley, said she is concerned about the ramifications for access to care in South Texas, many parts of which already face a dire shortage of physicians. "I've taken three courses in ICD-10, and I still don't get it," Dr. Villarreal said.

But Washington watchers say Congress has no stomach for delaying the implementation date one more time. "The ICD-10 Coalition has done a better job than [medicine has] over the past four years," one delegate said.

That leaves organized medicine in a tough spot, said Fort Worth pediatrician Gary Floyd, MD, a member of the TMA Board of Trustees. Groups like AMA and TMA must continue to push for a last-minute reprieve and at the same time work to protect their members from the likely upheaval that will come with ICD-10, he explained.

"Our message is this," Dr. Floyd said, "don't give up the ship, but make sure the lifeboats are manned and at the ready."

Physicians line up to testify on ICD-10

One likely outcome of the House of Delegates meeting will be a directive for AMA to push the Centers for Medicare & Medicaid Services (CMS) for some leeway for physicians who can't master the intricacies of ICD-10 right away.

"We simply need to implement ICD-10 as planned and ask for a grace period where we are not held financially accountable for improper coding in order to protect our patients access to care and to protect physicians’ practices," said Alabama urologist Jeff Terry, MD, who has been an outspoken critic of ICD-10 for the past several years. He said a bill introduced last week in Congress by U.S. Rep. Gary Palmer (R-Alabama) would set up such a grace period.

In testimony before the reference committee today, Dr. Terry, Dr. Floyd, and others outlined a series of protections they want AMA request from CMS:

Two years with no penalties for incorrect coding;

Two years with no bounty-hunting auditors looking for coding errors;

A promise of no delay in payments to physicians; and

Acceptance of ICD-10 codes with less-than-optimal degrees of specificity.

Dr. Floyd describes the terms of

the ICD-10 grace period.

The reference committee's recommendations are expected early Monday, and the full House of Delegates will debate the issues before the meeting ends on Wednesday.

(CHICAGO) -- With an uncontested race, the outcome was all but certain ... but the celebration was real.

After a four-year stint in the No. 2 spot, Fort Worth allergist Sue Bailey, MD, today won election as speaker of the American Medical Association House of Delegates. She moved up one notch after the current speaker -- Andy Gurman, MD, of Pennsylvania, was chosen AMA president-elect.

"I love this house, and I love this organization," Dr. Bailey said after the delegates elected her by acclamation. "I look forward to continuing our robust work to improve the health of our nation together."

Dr. Henkes nominating Dr. Bailey

David Henkes, MD, of San Antonio, chair of the Texas Delegation to the AMA, placed Dr. Bailey's name in nomination. "Sue Bailey is a good person, a nice person, a wise person, and a wonderful mentor," Dr. Henkes said. "I guarantee you, the physicians of Texas would follow wherever she leads – and this house would be well-advised to do the same."

Dr. Bailey has a long history of service to organized medicine, beginning with her stints as chair of the medical student sections of both the Texas Medical Association and the AMA. She chaired the TMA Council on Communication and served as speaker of the TMA House of Delegates before winning election as TMA's 145th president in 2010. She also was president of the Tarrant County Medical Society.

At the AMA, she has served as chair of the Texas Delegation, as a member and chair of the AMA Council on Medical Education, and as the AMA representative on the board of the Accreditation Council for Continuing Medical Education. She has served as vice speaker of the AMA House of Delegates since 2011.

Dr. Gurman (l) congratulates Dr. Bailey

Dr. Bailey is an allergist in private practice at Fort Worth Allergy and Asthma Associates. She previously served as an associate consultant at the Mayo Clinic's department of pediatrics in Rochester, Minn. She is board certified in allergy, and immunology, and pediatrics.

Dr. Bailey received her medical degree from Texas A&M Health Science Center College of Medicine and later served on the A&M Board of Regents. She completed her residency in general pediatrics and her fellowship in allergy/immunology at Minnesota's Mayo Graduate School of Medicine.